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Crisis Intervention In the Classroom Adapted from Intermediate CIT Course Number 3841 Texas Commission Crisis Intervention In the Classroom Adapted from Intermediate CIT Course Number 3841 Texas Commission on Law Enforcement Officer Standards and Education 1

Crisis Intervention For The Classroom • Originally for Peace Officers, we’ve adapted it. • Crisis Intervention For The Classroom • Originally for Peace Officers, we’ve adapted it. • Purpose: To develop a basic understanding of mental illness and offer strategies for dealing with a psychological crisis. 2

Helpful Resource ASSISTING THE DISTRESSED STUDENT www. venturacollege. edu/assets/pdf/shps_assistingdistressedst udent. pdf 3 Helpful Resource ASSISTING THE DISTRESSED STUDENT www. venturacollege. edu/assets/pdf/shps_assistingdistressedst udent. pdf 3

Other Resources • Deadly Lessons: Understanding Lethal School Violence – http: //www. nap. edu/catalog. Other Resources • Deadly Lessons: Understanding Lethal School Violence – http: //www. nap. edu/catalog. php? record_id=1 0370 • Understanding Mental Illness: Factsheet – http: //www. samhsa. gov/Mental. Health/understanding_ Mentalllness_Factsheet. aspx 4

Origin of the Training • Memphis (TN) officers shot and killed a 26 -year-old Origin of the Training • Memphis (TN) officers shot and killed a 26 -year-old male who was cutting himself with a knife and threatening suicide • The public outcry in the aftermath of the shooting caused the mayor to establish a task force 5

Headlines… “Training urged after police shooting” “The weekend death of a mentally disabled man Headlines… “Training urged after police shooting” “The weekend death of a mentally disabled man shot by a Miami-Dade police officer… department to offer its officers more intensive training. ” — The Miami Herald — Herald. com — Posted Thursday, October 28, 2004 6

And thus, C. I. T. • Recognize the community mindset as it relates to And thus, C. I. T. • Recognize the community mindset as it relates to the mentally ill’s relationship with law enforcement personnel 7

The Law Enforcement Paradox • By taking a less physical, less authoritative, less controlling, The Law Enforcement Paradox • By taking a less physical, less authoritative, less controlling, less confrontational approach the officer usually has more authority and control over the person in a mental health crisis. 8

Police Magazine (March 2000) • “The essential difference between suspect encounter training, that officers Police Magazine (March 2000) • “The essential difference between suspect encounter training, that officers traditionally receive, and how to approach the mentally ill is the need to be nonconfrontational. Such a requirement to, in effect, switch gears is diametrically opposed to the way officers are routinely expected to control conflict. ” 9

Police Magazine (March 2000) • “The same command techniques that are employed to take Police Magazine (March 2000) • “The same command techniques that are employed to take a criminal suspect into custody can only serve to escalate a contact with the mentally ill into violence. ” 10

From Police to Instructors • We transition then into the classroom. 11 From Police to Instructors • We transition then into the classroom. 11

A Crisis Requires Intervention • “A psychological crisis situation occurs when the student feels A Crisis Requires Intervention • “A psychological crisis situation occurs when the student feels unable to cope with the circumstances of his/her life. The more helpless the individual feels, the greater the crisis. Typically, a person may be temporarily overwhelmed and unable to carry on, but is not in immediate physical danger. ” • http: //www. venturacollege. edu/assets/pdf/shps_assistingdistressedstudent. pdf 12

Mental Illness can escalate into violence A psychological emergency occurs when a person is: Mental Illness can escalate into violence A psychological emergency occurs when a person is: – Suicidal – Aggressive towards others – Gravely impaired: confused, agitated, disoriented, having hallucinations or delusions (Source: http: //www. venturacollege. edu/assets/pdf/shps_assistingdistress edstudent. pdf) 13

Cho’s Communications With Instructors • http: //www. collegiatetimes. com/topic/cho Seung-Hui Cho 14 Cho’s Communications With Instructors • http: //www. collegiatetimes. com/topic/cho Seung-Hui Cho 14

Mental Illness Is Not A Crime! • Mentally ill are not criminals. • Mentally Mental Illness Is Not A Crime! • Mentally ill are not criminals. • Mentally ill are not less intelligen • Mentally ill can lead productive, fulfilling lives. 15

Crisis Intervention in The College Classroom? “A student’s behavior, especially if it is inconsistent Crisis Intervention in The College Classroom? “A student’s behavior, especially if it is inconsistent with your previous observations, could well constitute an inarticulate attempt to draw attention to his/her plight…“cry for help. ” 16

The College Classroom (continued) “…A change in an individual’s behavior could also be caused The College Classroom (continued) “…A change in an individual’s behavior could also be caused by a change in his/her psychological medication or failure to take medication that day. ” Source: venturacollege. edu/assets/pdf/shps_assistingdistressedstud ent. pdf 17

Safety… • FBI statistics state that mentally ill consumers are no more prone to Safety… • FBI statistics state that mentally ill consumers are no more prone to violence than any other area of the population. • HOWEVER, the variables(mental instability, high emotions, possible paranoia/delusions and substance abuse) can be very dangerous if not handled appropriately. 18

Safety… • When a person feels cornered, especially if psychotic , chances are high Safety… • When a person feels cornered, especially if psychotic , chances are high their response would be violent. • In crisis, reason takes a back seat to emotion. 19

Law Enforcement Policy Center • “Officers should avoid approaching the subject until a degree Law Enforcement Policy Center • “Officers should avoid approaching the subject until a degree of rapport has been developed. ” • “All attempts should be used to communicate with the person first by allowing him to ventilate. ” 20

Police Research Forum • “Do not rush the person or crowd his personal space. Police Research Forum • “Do not rush the person or crowd his personal space. Any attempt to force an issue may quickly backfire in the form of violence. ” • “He may be waving his fists, or a knife, or yelling. If the situation is secure, and if no one can be accidentally harmed by the individual, you should adopt a *nonconfrontational stance with the subject. ” 21

Basic Facts • There are two distinct types of menta illnesses – Serious to Basic Facts • There are two distinct types of menta illnesses – Serious to persistent mental illnesses which are caused by psychological, biological, genetic, or environmental conditions – Situational mental illnesses due to severe stress which may be only temporary 22

Basic Facts • Anyone can have a mental illness, regardless of age, gender, race Basic Facts • Anyone can have a mental illness, regardless of age, gender, race or socioeconomic level. • Mental illnesses are more common than cancer, diabetes, heart disease or AIDS. • Mental illness can occur at any age. 23

Basic Facts • 20 - 25% of individuals may be affected by mental illness. Basic Facts • 20 - 25% of individuals may be affected by mental illness. • 7. 5 million children are affected by mental, developmental or behavioral disorders. 24

Basic Facts • Nearly two-thirds of all people with a diagnosable mental disorder do Basic Facts • Nearly two-thirds of all people with a diagnosable mental disorder do not seek treatment. 25

Four Main Categories • Four prominent categories of mental illness. 26 Four Main Categories • Four prominent categories of mental illness. 26

Categories of mental illness 1. 2. 3. 4. Personality Disorders Mood Disorders Psychosis *Developmental Categories of mental illness 1. 2. 3. 4. Personality Disorders Mood Disorders Psychosis *Developmental Disorders (*not mentioned today) 27

Personality Disorders • Personality Disorders as they relate to educator contact. 28 Personality Disorders • Personality Disorders as they relate to educator contact. 28

Personality Disorders • Many individuals who are functioning well in their lives may still Personality Disorders • Many individuals who are functioning well in their lives may still have a personality disorder. • Many with personality disorders also suffer with depression. • May be seen in persons with chemical dependency problems. 29

Causes • May be caused by family history of physical or emotional abuse, lack Causes • May be caused by family history of physical or emotional abuse, lack of structure and responsibility, poor relationship with parent(s), and alcohol or drug abuse. 30

Three Most Common Personality Disorders • Three most common personality disorders encountered by law Three Most Common Personality Disorders • Three most common personality disorders encountered by law enforcement officers, may very well be seen in the classroom. 31

Personality Disorders • Paranoid • Antisocial • Borderline 32 Personality Disorders • Paranoid • Antisocial • Borderline 32

Personality Disorders: Paranoid • Interpret actions of others as threatening. • Foresee being harmed. Personality Disorders: Paranoid • Interpret actions of others as threatening. • Foresee being harmed. • Perceive that others have dismissed them, or they have been “disrespected” by others. 33

Personality Disorders: Antisocial • • • Most commonly in males. Irresponsible antisocial behavior. Diagnosed Personality Disorders: Antisocial • • • Most commonly in males. Irresponsible antisocial behavior. Diagnosed after age 18. Trouble with authority. Know doing wrong, do it anyway. 34

Antisocial - Traits • • • History of truancy or runaway Starting fights Using Antisocial - Traits • • • History of truancy or runaway Starting fights Using weapons Physically abusing animals or people Lying Stealing or other illegal behavior 35

Borderline • Most commonly recognized in females - possible traits: – Unstable and intense Borderline • Most commonly recognized in females - possible traits: – Unstable and intense personal relationships – Impulsiveness with relationships, spending, food, drugs, sex – Intense anger or loss of control 36

Borderline (continued) • Recurrent suicidal threats • Chronic feelings of emptiness or boredom • Borderline (continued) • Recurrent suicidal threats • Chronic feelings of emptiness or boredom • Feelings of abandonment 37

Prevalent Behaviors • Identify prevalent behaviors associated with personality disorders. 38 Prevalent Behaviors • Identify prevalent behaviors associated with personality disorders. 38

Behaviors • Usually do not seek treatment because they do not think there is Behaviors • Usually do not seek treatment because they do not think there is a problem. • “Normal” functioning, but display specific personality traits (inflexible, maladaptive, situational inappropriateness). • Believe problems are caused by outside sources or ‘system’ at large. 39

Behaviors continued • Behavior may lead to breaking laws (theft, hot-check writing, fraud etc. Behaviors continued • Behavior may lead to breaking laws (theft, hot-check writing, fraud etc. ) and activity in the criminal justice system. • Alcohol and illegal drugs are commonly used to ‘self medicate’ as a result of stress and behavioral consequences. • Often need treatment for chemical dependency or depression. 40

Recognizable Behaviors continued… - Impaired judgment Explosive temper Increased spending Delusions 41 Recognizable Behaviors continued… - Impaired judgment Explosive temper Increased spending Delusions 41

Suicide + Mental Illness = • Suicide and its relationship with mental illness. 42 Suicide + Mental Illness = • Suicide and its relationship with mental illness. 42

Suicide and Mental Illness • 90% of suicides are reportedly related to untreated or Suicide and Mental Illness • 90% of suicides are reportedly related to untreated or under-treated mental illness • The most common mental illness associated with suicide is depression. 43

Some Startling Facts • Nearly 20% of people diagnosed with bipolar disorder die from Some Startling Facts • Nearly 20% of people diagnosed with bipolar disorder die from suicide • 10% - 15% of people diagnosed with Schizophrenia die from suicide 44

Mood Disorders • Mood Disorders as they relate to officer and educator contact. 45 Mood Disorders • Mood Disorders as they relate to officer and educator contact. 45

Causes of Mood Disorders? • Researchers believe that a complex imbalance in the brain’s Causes of Mood Disorders? • Researchers believe that a complex imbalance in the brain’s chemical activity plays a prominent role in selectivity (SAMHSA). • Environmental factors can trigger or buffer against the onset. 46

Common Mood Disorders • Two most common mood disorders encountered by law enforcement officers, Common Mood Disorders • Two most common mood disorders encountered by law enforcement officers, and you as college faculty may see these in the classroom: – Depression – Bipolar Disorder 47

Depression • Depression is a natural reaction to trauma, loss, death or change. • Depression • Depression is a natural reaction to trauma, loss, death or change. • A major depressive syndrome is defined as a depressed mood or loss of interest at least two weeks in duration. 48

Major Depression • Unlike normal emotional experiences of sadness, loss, or passing mood states, Major Depression • Unlike normal emotional experiences of sadness, loss, or passing mood states, major depression is persistent and can significantly interfere with an individual’s thoughts, behavior, mood, activity, and physical health. 49

Symptoms of Major Depression • Pronounced changes in sleep, appetite, and energy • Profoundly Symptoms of Major Depression • Pronounced changes in sleep, appetite, and energy • Profoundly sad or irritable mood • Difficulty thinking, concentrating, and remembering • Chronic fatigue 50

Symptoms continued • Physical slowing or agitation • Loss of interest in usual activities Symptoms continued • Physical slowing or agitation • Loss of interest in usual activities • Feelings of hopelessness or excessive guilt • Recurrent thoughts of death or suicide 51

Symptoms continued… Persistent physical symptoms that do not respond to treatment, such as headaches, Symptoms continued… Persistent physical symptoms that do not respond to treatment, such as headaches, digestive disorders, and chronic pain. 52

Depression: Causes There is no one single cause of major depression. Psychological, biological, genetic, Depression: Causes There is no one single cause of major depression. Psychological, biological, genetic, and environmental factors may all contribute to its development. 53

Major Depression • Affects approximately 9. 9 million American adults, or about 5. 0 Major Depression • Affects approximately 9. 9 million American adults, or about 5. 0 percent of the U. S. population age 18 and older in a given year. 54

Major Depression • Nearly twice as many women as men suffer from major depression Major Depression • Nearly twice as many women as men suffer from major depression • While major depressive disorder can develop at any age, the average at onset is the mid-twenties. 55

Bipolar Disorder • Mental Illness (manic depression) involving mania (an intense enthusiasm) and depression Bipolar Disorder • Mental Illness (manic depression) involving mania (an intense enthusiasm) and depression (as discussed previously). • Bipolar disorder causes extreme shifts in mood, energy, and functioning. • Chronic disease affecting more than two million individuals in the U. S. 56

“Ups & Downs” Of Manic Depression • “Highs” get fewer • Lows get worse “Ups & Downs” Of Manic Depression • “Highs” get fewer • Lows get worse & prolonged 57

Symptoms of Mania • Elated, happy mood or irritable, angry, unpleasant mood • Increased Symptoms of Mania • Elated, happy mood or irritable, angry, unpleasant mood • Increased activity or energy • Inflated self-esteem • Decreased need for sleep 58

Symptoms…continued • Streaming ideas or feeling of thoughts racing • More talkative than usual Symptoms…continued • Streaming ideas or feeling of thoughts racing • More talkative than usual • Excessive risk-taking • Ambitious often grandiose plans • Increased sexual interest and activity 59

Manic Depression Video View “Manic Depression” video 60 Manic Depression Video View “Manic Depression” video 60

Causes? • Sometimes serious life events such as a serious loss, chronic illness, or Causes? • Sometimes serious life events such as a serious loss, chronic illness, or financial problem, may trigger an episode in individuals with a predisposition to the disorder. 61

Bipolar Disorder • Affects approximately 2. 3 million American adults, or about 1. 2 Bipolar Disorder • Affects approximately 2. 3 million American adults, or about 1. 2 percent of the U. S. population age 18 and older in a given year. 62

Bipolar Disorder • The average at onset for a first manic episode is the Bipolar Disorder • The average at onset for a first manic episode is the early twenties. • Men and women are equally likely to develop bipolar disorder. 63

Psychosis • Psychosis and how it relates to officer (educator) contact. 64 Psychosis • Psychosis and how it relates to officer (educator) contact. 64

Psychosis: A Definition • “A group of serious and often debilitating mental disorders that Psychosis: A Definition • “A group of serious and often debilitating mental disorders that may be of organic or psychological origin and are characterized by some or all of the following symptoms: - Impaired thinking and reasoning ability - Perceptual distortions - Inappropriate emotional responses 65

Psychosis…continued - Inappropriate affect - Regressive behavior - Reduced impulse control and - Impaired Psychosis…continued - Inappropriate affect - Regressive behavior - Reduced impulse control and - Impaired reasoning of reality. Social Work Dictionary, 2 nd Edition, by Robert L. Baker 66

More On Psychosis • A distortion of reality that may be accompanied by delusions More On Psychosis • A distortion of reality that may be accompanied by delusions and hallucinations. • Delusion: False beliefs not based on factual information. • Hallucination: Distortion in the senses…. experiencing auditory or visual feedback that is not there. 67

Psychosis: common experiences • Hearing voices: “Die, die, ” “Kill yourself, ” “You’re no Psychosis: common experiences • Hearing voices: “Die, die, ” “Kill yourself, ” “You’re no good, ” “They are going to get you. ” • Feelings of Paranoia • Visual hallucinations • Heightening of senses 68

Psychosis: Cues • Behavioral/emotional cues a person displays when experiencing a psychotic episode. 69 Psychosis: Cues • Behavioral/emotional cues a person displays when experiencing a psychotic episode. 69

Cues • Behavioral Cues: Inappropriate dress, impulsive body movements, causing injury to self. • Cues • Behavioral Cues: Inappropriate dress, impulsive body movements, causing injury to self. • Emotional Cues: Lack of emotional response, inappropriate emotional reactions. 70

Class Exercise Volunteers Anyone? 71 Class Exercise Volunteers Anyone? 71

Psychosis Video (View ‘’ 20/20 newscast’ from “Train the Trainer” materials) 72 Psychosis Video (View ‘’ 20/20 newscast’ from “Train the Trainer” materials) 72

1. 2. 12. Schizophrenia • Discuss Schizophrenia as it relates to psychosis. 73 1. 2. 12. Schizophrenia • Discuss Schizophrenia as it relates to psychosis. 73

Schizophrenia • Group of psychotic disorders characterized by changes in perception. • Affects a Schizophrenia • Group of psychotic disorders characterized by changes in perception. • Affects a person’s ability to think clearly, manage his or her emotions, make decisions, relate to others, and distinguish fact from fiction. 74

Distorted thinking… • Results in: - Hallucinations - Poor processing of information/Attention deficit - Distorted thinking… • Results in: - Hallucinations - Poor processing of information/Attention deficit - Illogical thinking that can result in disorganized and rambling speech and delusions. 75

Changes in Emotion… • May overreact to situation. • Have “flat effect” (Decreased emotional Changes in Emotion… • May overreact to situation. • Have “flat effect” (Decreased emotional expressiveness, diminished facial expression and apathetic appearance). 76

Changes in Emotion…continued • Anhedonia Lacking pleasure or : interest in activities that were Changes in Emotion…continued • Anhedonia Lacking pleasure or : interest in activities that were once enjoyable. • Withdrawn: Media tends to portray as violent which is very rare. 77

Schizophrenia • It affects approximately 2. 2 million individuals in the U. S. age Schizophrenia • It affects approximately 2. 2 million individuals in the U. S. age 18 and older in a given year. • Ranks among the top 10 causes of disability in developed countries worldwide. • Higher risk of suicide. Approximately 10 -15% of people with schizophrenia commit suicide. 78

1. 2. 14. Psychotic Episode • Communicative approach an officer (or educator) should take 1. 2. 14. Psychotic Episode • Communicative approach an officer (or educator) should take when confronting a person in a psychotic episode. 79

Communicative Approach 1. Be cautious. 2. Never startle the person. 3. Be patient, you Communicative Approach 1. Be cautious. 2. Never startle the person. 3. Be patient, you may have to repeat several times. 4. Try to learn the person’s name and use it. 5. Talk in a calm, soft tone of voice. 80

Advanced Communication Modes • Advanced modes of communication. 81 Advanced Communication Modes • Advanced modes of communication. 81

In The First 3 Minutes… • List the components of the “first three minute In The First 3 Minutes… • List the components of the “first three minute assessment. ” 82

First Three Minute Assessment: Four Components Elements of Evaluation • Intellectual Functioning • Behavioral First Three Minute Assessment: Four Components Elements of Evaluation • Intellectual Functioning • Behavioral Reactions • Emotional Reactions 83

Evaluate: Intellectual Functioning • • • Clear/Alert vs. Foggy/Confused Difficulty in Understanding Stream of Evaluate: Intellectual Functioning • • • Clear/Alert vs. Foggy/Confused Difficulty in Understanding Stream of Mental Activity Over Productive Delusions/Hallucinations 84

Behavioral Reactions • • • Attitude Controlled Behavior Coordination/ Gait* Distrusting/Withdrawn/Isolates Self Shy/Meek/Introverted 85 Behavioral Reactions • • • Attitude Controlled Behavior Coordination/ Gait* Distrusting/Withdrawn/Isolates Self Shy/Meek/Introverted 85

Evaluate: Emotional Reactions • • Low/Depressed/Sad Volatile/Emotional swings Helpful/Motivated/Caring Suspicious Irritable/Annoyed/Angry Bitter Bullying 86 Evaluate: Emotional Reactions • • Low/Depressed/Sad Volatile/Emotional swings Helpful/Motivated/Caring Suspicious Irritable/Annoyed/Angry Bitter Bullying 86

Strange Behavior Can Serve As A Signal 87 Strange Behavior Can Serve As A Signal 87

Northern Illinois University, Feb. 14, 2008 Stephen Kazmierczak A college gunmen was Northern Illinois University, Feb. 14, 2008 Stephen Kazmierczak A college gunmen was "off his medication" for an undisclosed condition before he opened fire on an Illinois university campus, the police chief of De. Kalb Ill. , said Thursday. Source: http: //www. foxnews. com/story/0, 2933, 330805, 00. html 88

Northern Illinois University Shooting It is not known whether Stephen Kazmierczak, 27, who killed Northern Illinois University Shooting It is not known whether Stephen Kazmierczak, 27, who killed five people and himself at Northern Illinois University on Valentine's Day, was suffering from mental illness or some other condition. But police did say that, much like the shooter that left 32 people dead at Virginia Tech in April 2007, Kazmierczak was acting erractically in the weeks before the shooting. 89

L. E. A. P. S. • • • L isten E mpathize A sk L. E. A. P. S. • • • L isten E mpathize A sk P araphrase S ummarize 90

Characteristics to Positive Communication • • • Introductions Opening Statements Reflecting Statements Methods for Characteristics to Positive Communication • • • Introductions Opening Statements Reflecting Statements Methods for Gaining Trust Communication to Defuse 91

Opening Statements • Initial contact does several things: – Establishes leadership role in conversation Opening Statements • Initial contact does several things: – Establishes leadership role in conversation – Identifies ultimate goal to resolve situation – Allows student to respond with immediate thoughts creating dialogue 92

Opening Statements: examples • “Tell me what your problems are? ” • “I want Opening Statements: examples • “Tell me what your problems are? ” • “I want to understand what you need”. • “I understand what has happened and I want to help you understand the consequences. ” • “I would like to work with you to find solutions to your problem. ” 93

Reflecting Statements • Encourage Communication • Neutral Responses/Encourage Talking • Examples: – “I see…” Reflecting Statements • Encourage Communication • Neutral Responses/Encourage Talking • Examples: – “I see…” – “Tell me about it…” – “That would be one solution…” – “What other options do you have…” 94

Methods for Gaining Trust • • Honesty/Sincerity Follow Through Validation of Positive Actions Forewarn Methods for Gaining Trust • • Honesty/Sincerity Follow Through Validation of Positive Actions Forewarn 95

Examples… • “I’m not going to lie to you. You made a failing grade Examples… • “I’m not going to lie to you. You made a failing grade on the test. ” • “You have been straightforward with me, so I am going to be straightforward with you…” • “I’d like you to go to the counseling center; if you don’t mind, I’m going to walk with you. ” 96

Communication to Defuse • Show understanding/empathy • Reassure • Allow ventilation 97 Communication to Defuse • Show understanding/empathy • Reassure • Allow ventilation 97

Barriers • Barriers to active communication. 98 Barriers • Barriers to active communication. 98

Level of Communication • Barrier: Complicated Instructions • Communicate on a level that is Level of Communication • Barrier: Complicated Instructions • Communicate on a level that is easy for the consumer to understand respond. • Keep vocabulary simple. Example: – “I need to talk privately with you. ” OR – “We need to step out in the hall. ” 99

Barrier: Lack of Active Listening • Arguing • Criticizing • Jumping to Conclusions • Barrier: Lack of Active Listening • Arguing • Criticizing • Jumping to Conclusions • Pacifying • • • Derailing Moralizing Name-Calling Ordering Patronizing 100

Active Listening • Discuss three levels of active listening. 101 Active Listening • Discuss three levels of active listening. 101

Three Levels of Active Listening 1. Listening to Words 2. Listening to Whole Messages Three Levels of Active Listening 1. Listening to Words 2. Listening to Whole Messages 3. Reflecting the Whole Message 102

Techniques to Active Listening 1. Repeating 2. Paraphrasing 3. Reflection of Feelings 103 Techniques to Active Listening 1. Repeating 2. Paraphrasing 3. Reflection of Feelings 103

Repeating Simply restate what the person has said in his words • This helps Repeating Simply restate what the person has said in his words • This helps ensure you heard what you think you heard • If possible…use less provocative language to defuse a situation “Blowing someone away” vs. “Harming someone” 104

Paraphrasing • Go beyond what was stated in an attempt to understand the meaning Paraphrasing • Go beyond what was stated in an attempt to understand the meaning behind the words. • Be careful not to lead with your own feelings. • Example: “It sounds like you are really worried about your family right now. ” 105

Reflection of Feelings • Express awareness of other persons feelings • Example: “You sound Reflection of Feelings • Express awareness of other persons feelings • Example: “You sound depressed…. ” 106

Top 5 Things Not To Say • “You do not have a headache from Top 5 Things Not To Say • “You do not have a headache from a computer chip planted in your brain…” • “You’re acting crazy. ” • “I don’t have time for this foolishness. ” • “You’re over-reacting. ” • “You’re not really going to kill yourself. ” 107

Psychological Crisis “A psychological crisis situation occurs when the student feels unable to cope Psychological Crisis “A psychological crisis situation occurs when the student feels unable to cope with the circumstances of his/her life…. Typically, a person may be temporarily overwhelmed and unable to carry on, but is not in immediate physical danger. 108

psychological emergency • A psychological emergency exists when the crisis is so severe that psychological emergency • A psychological emergency exists when the crisis is so severe that the person is potentially in danger and may need to be hospitalized. • Suicidal • Aggressive towards others • Gravely impaired: confused, agitated, disoriented, having hallucinations or delusions 109

Basic Strategies • Basic strategies that are necessary when communicating in crisis situations. 110 Basic Strategies • Basic strategies that are necessary when communicating in crisis situations. 110

In A Crisis , You May Decide To. . . • Remove the student In A Crisis , You May Decide To. . . • Remove the student from the classroom. • Remove the classroom from the students. • Ask the student to call a family member or close friend. • Make student aware of resources (counseling). • Notify counseling and *law enforcement. 111

In An Emergency, You Should… • Think safety – students, instructor, and mentally disturbed. In An Emergency, You Should… • Think safety – students, instructor, and mentally disturbed. • “Class is now over” – students should leave the classroom (unless a threat exists outside the classroom). • Call police and counseling – or have others call. 112

Communication/Interaction Skills • • Safety Crisis Facts Language Movements 113 Communication/Interaction Skills • • Safety Crisis Facts Language Movements 113

Safety • Your personal safety comes first. – “Should I be alone with this Safety • Your personal safety comes first. – “Should I be alone with this person? ” – If not, then DON’T! • Control the surroundings. – Closed office or out in open • Remove harmful obstacles from the surroundings. 114

Crisis Notes • Person in distress is usually excited, alarmed or confused. • Control Crisis Notes • Person in distress is usually excited, alarmed or confused. • Control is very important to persons in crisis. • When a person feels cornered, which translates to lack of control, they may respond with violence. 115

Instructor’s Response • Listen. Avoid any physical contact and allow the student to talk. Instructor’s Response • Listen. Avoid any physical contact and allow the student to talk. • Assist. Provide a quiet atmosphere; minimize environmental stimulation. Give the student some space. Ask the student what or who might be helpful. • Recognize. Know your limitations. 116

Strategies For Crisis • • • Stay calm Avoid “crowding” Restate Use person’s name Strategies For Crisis • • • Stay calm Avoid “crowding” Restate Use person’s name Give instructions one at a time • Engagement is pivotal • Don’t underestimate the power of hallucinations or delusions • Ask about treatment history • Don’t express disapproval 117

Language • Use person’s name • Be patient and frequently consistent • Avoid direct Language • Use person’s name • Be patient and frequently consistent • Avoid direct • Be aware of slower confrontation, labels reaction time… and acronyms responses may be given slower than • Limit number of you expect instructions 118

Movements • Be aware of body movements • People in crisis often need more Movements • Be aware of body movements • People in crisis often need more personal space • Keep movements slow and deliberate 119

QUESTIONS? 120 QUESTIONS? 120

Thanks! 121 Thanks! 121

Overview Of Suicide 122 Overview Of Suicide 122

Watch For Suicide • Develop a knowledge base concerning suicide and the evaluation of Watch For Suicide • Develop a knowledge base concerning suicide and the evaluation of danger levels. 123

Suicide • Commonly stated myths about suicide: 124 Suicide • Commonly stated myths about suicide: 124

Myths… • People who talk about suicide won’t commit suicide. • People who commit Myths… • People who talk about suicide won’t commit suicide. • People who commit suicide are “crazy. ” • Once the person begins to improve, the risk has ended. • Prior unsuccessful suicide attempts means there will never be a successful suicide. 125

 Fact § “There is no typical suicide victim. It happens to young and Fact § “There is no typical suicide victim. It happens to young and old, rich and poor. ” American Association of Suicidology 126

Evaluating Level of Suicidal Danger • Symptoms? • Nature of current stressor? • Method Evaluating Level of Suicidal Danger • Symptoms? • Nature of current stressor? • Method and degree? • Prior attempt? 127

Levels of danger…continued • Acute vs. chronic? • Medical status? • Chance of rescue? Levels of danger…continued • Acute vs. chronic? • Medical status? • Chance of rescue? • Social resources? 128

Danger to Self • Intent (actions/words) • Gross neglect for personal safety • Specific Danger to Self • Intent (actions/words) • Gross neglect for personal safety • Specific plan (action/words) • Plans/means available 129

Danger to Others • Intent (actions/words) • Specific person identified • Agitated, angry, explosive Danger to Others • Intent (actions/words) • Specific person identified • Agitated, angry, explosive • Irrational, impulsive, reckless (intent/actual) 130

Statistics 131 Statistics 131

Medications • Name four categories of medications utilized in controlling the symptoms of mental Medications • Name four categories of medications utilized in controlling the symptoms of mental illness. 132

Categories of drugs • Anti-psychotic – Thorazine, Mellaril, Haldol – Controls hallucinations – Ex: Categories of drugs • Anti-psychotic – Thorazine, Mellaril, Haldol – Controls hallucinations – Ex: Schizophrenia 133

Categories…continued • Antidepressants – Elavil, Prozac, Zoloft – Control feelings of sadness, hopelessness, suicidal Categories…continued • Antidepressants – Elavil, Prozac, Zoloft – Control feelings of sadness, hopelessness, suicidal thoughts – Ex: depression 134

Categories…continued • Mood Stabilizers – Tegratol, Lithium, Depakote – Control mood swings – Ex: Categories…continued • Mood Stabilizers – Tegratol, Lithium, Depakote – Control mood swings – Ex: bipolar disorder 135

Categories…continued • Anti-anxiety drugs – Xanax, Valium, Buspar – Feeling of powerlessness, extreme apprehension, Categories…continued • Anti-anxiety drugs – Xanax, Valium, Buspar – Feeling of powerlessness, extreme apprehension, panic – Ex: Phobia’s, Post Traumatic Stress Disorder 136

Side Effects of Meds • List possible side effects with the use of psychotropic Side Effects of Meds • List possible side effects with the use of psychotropic medications. 137

Examples of side effects • • • Muscle spasms Protruding tongue Eyes rolled back Examples of side effects • • • Muscle spasms Protruding tongue Eyes rolled back Constant leg movement Tremors Uncoordinated movements • Impotence • • • Nausea Headache Blurred vision Weight gain Fatigue Liver toxicity 138

 Side effects can be… • Uncomfortable • Dehumanizing • Often irreversible 139 Side effects can be… • Uncomfortable • Dehumanizing • Often irreversible 139

Side effects…. continued • Some side effects are permanent, even after medications are stopped Side effects…. continued • Some side effects are permanent, even after medications are stopped • Some of these medications are associated with neurological damage • Some of these medications can be lethal 140

1. 4. 3. • Discuss “old” vs. “new” medications. 141 1. 4. 3. • Discuss “old” vs. “new” medications. 141

‘Old’ vs. ‘New’ Medications • ‘New’ Drugs have significantly fewer side effects • ‘Old ‘Old’ vs. ‘New’ Medications • ‘New’ Drugs have significantly fewer side effects • ‘Old ’ Drugs still used today especially with indigent, jail populations etc. due to lower cost 142

Why Don’t You Take It? • Three primary reasons why consumers do not take Why Don’t You Take It? • Three primary reasons why consumers do not take their medications as prescribed. – Side effects – Stigma – Start feeling better • Continuous problem for law enforcement…the above deviations are the primary cause of crisis concerns. 143

Some Warning Signals • Social withdrawal. • Excessive feelings of isolation and being alone. Some Warning Signals • Social withdrawal. • Excessive feelings of isolation and being alone. • Excessive feelings of rejection. • Being a victim of violence. • Feelings of being picked on and persecuted • Low school interest and poor academic performance. Source: “Early Warning, Timely Response: A Guide to Safe Schools” 144

Some Warning Signals • Uncontrolled anger • Patterns of impulsive and chronic hitting, intimidating, Some Warning Signals • Uncontrolled anger • Patterns of impulsive and chronic hitting, intimidating, and bullying behaviors. • History of discipline problems. • Past history of violent and aggressive behavior. Source: “Early Warning, Timely Response: A Guide to Safe Schools” 145

Some Warning Signals • • • Expression of violence in writings and drawings Inappropriate Some Warning Signals • • • Expression of violence in writings and drawings Inappropriate access to firearms Gang affiliation Serious threats of violence. Source: “Early Warning, Timely Response: A Guide to Safe Schools” 146

School Violence Is Not New • Poe Elementary School, Houston, Texas • Tuesday, September School Violence Is Not New • Poe Elementary School, Houston, Texas • Tuesday, September 15, 1959 49 -year-old tile contractor Paul Harold Orgeron went to his mother's house to pick up his son, Dusty, so that he could enroll him at Poe Elementary School… Paul took Dusty to the school's principal's office, Mrs. R. E. Doty, while carrying a briefcase…Paul handed two notes to second grade teacher Miss Johnston. The notes were written illegibly and incoherently …an explosion… 147

Poe Elementary School, 1959 “The explosion killed Paul, Dusty, William Hawes Jr. , John Poe Elementary School, 1959 “The explosion killed Paul, Dusty, William Hawes Jr. , John Cecil Fitch Jr. , teacher Jennie Kolter and the school custodian James Arlie Montgomery. Mrs. Doty had her clothes torn off from the blast and the grisly scene even affected the news reporters as they came to the site. ” Source: www. columbine-angels. com/School_Violence_Prior_to_August_1980. htm 148

Poe Elementary - Houston “…Seventeen other children were wounded. Earl and Robert Taylor needed Poe Elementary - Houston “…Seventeen other children were wounded. Earl and Robert Taylor needed their legs amputated to survive. Paul had a been convicted twice in Louisiana and once in Texas and for burglary and theft. ” 149

Charles Whitman, Aug. 1, 1966 Whitman killed his mother and wife. Then he killed Charles Whitman, Aug. 1, 1966 Whitman killed his mother and wife. Then he killed a total of 15 people and wounded 31 others. …On Monday, November 12, 2001, survivor David Gunby, 58, died in Fort Worth, Texas. He was shot in the back by Charles on August 1, 1966. The medical examiner ruled his death a homicide in conjunction with the shootings on the UT campus. 150

Monday, January 21, 1980 Springbrook High School, Silver Spring, MD. Jennifer Czeh, 17, and Monday, January 21, 1980 Springbrook High School, Silver Spring, MD. Jennifer Czeh, 17, and her boyfriend, Larry Wayne Crumb, began fighting shortly before 10 this morning in the school's parking lot. During the fight Larry stabbed her in the stomach. 151

Columbine High School • April 20, 1999 • 12 killed • 23 wounded 152 Columbine High School • April 20, 1999 • 12 killed • 23 wounded 152

No Typical Assailant Students often communicate their plans before attacks. Kip Kinkel wrote in No Typical Assailant Students often communicate their plans before attacks. Kip Kinkel wrote in his journal, "Hate drives me. . I am so full of rage. . Everyone is against me. . As soon as my hope is gone, people die. " After he was expelled for bringing a gun to school in Springfield, Ore. , the 15 -yearold killed his parents, then two students in the school 153

School Violence “After he was expelled for bringing a gun to school in Springfield, School Violence “After he was expelled for bringing a gun to school in Springfield, Ore. , the 15 -year-old killed his parents, then two students in the school cafeteria, on May 21, 1998. ” 154